P958: REAL-WORLD TREATMENT PATTERNS IN PATIENTS INITIATING THIRD-LINE THERAPY FOR RELAPSED OR REFRACTORY MULTIPLE MYELOMA IN GERMANY, ITALY, THE UK, FRANCE, AND SPAIN
Authors: Karthik Ramasamy, K Martin Kortum, Evi Zhuleku, Elena Zamagni, Tim D’estrube, Soham Shukla, Moritz Lehne, Marco Ghiani, Maya Hanna, Ulf Maywald, Thomas Wilke, Lenka Kellermann, Sue Perera
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: Multiple myeloma (MM) is incurable, and patients (pts) require treatment (Tx) sequencing with multiple lines of therapy (LOTs). Real-world (RW) evidence on Tx patterns can provide insights into clinical practice and help identify standard-of-care and Tx gaps that signal unmet medical needs. Aims: To report RW Tx use in European pts with relapsed or refractory (RR) MM who initiated third-line (3L) Tx in 2016-2020 (Germany [DE], Italy [IT]) and 2016-2021 (UK, France [FR], Spain [ES]). Methods: In this retrospective analysis, DE and IT claims data were sourced from the German AOK PLUS health insurance fund (covering pts in Saxony and Thuringia) and Italian local health units covering 12 million pts, respectively. LOTs were defined using an algorithm based on prescription and procedure codes. UK, FR, and ES medical chart reviews (MCRs) were conducted to collect data between 2016-2018 (historical) and 2019-2021 (new) using electronic case report forms capturing a pt’s full Tx history per LOT. Historical vs new data were not captured for DE and IT. Results: The final pt sample included: DE (n=276), IT (n=289), the UK (n=401), FR (n=527), and ES (n=372; Table). Pts in DE were the oldest (median age, 75 years), and time since diagnosis and prior SCT was higher in the UK, FR, and ES than in DE and IT. IMiD–based regimens predominated in the 3L setting for all countries. Claims data showed that lenalidomide +dexamethasone (Rd) was the most common regimen in DE (12.7%) and IT (18.0%). In the new MCR data, ixazomib+Rd (IRd) was the most common 3L Tx in the UK (67.5%) and Rd was the most frequent historically (36.3%). Pomalidomide (P)-based regimens were preferentially used in FR, and Pd was most frequent in both the historical (33.9%) and new (17.1%) cohorts. In ES, Rd (19.7%) and daratumumab+bortezomib+d (DVd; 15.0%) were the most common historical and new regimens, respectively. In 2016-2018, R- and P-based 3L regimens were common, with high use of Rd and Pd doublets across the UK (>47%), FR (>46%), and ES (>33%). From historical to new, there was a shift toward triplets (notably in ES [~27% vs ~69%]), a general increase in anti-CD38 agents (FR [~15% vs ~52%], ES [~20% vs ~42%]), and less variation in regimens in the UK. Retreatment patterns in claims and new data MCR countries showed that 43%/98% (DE), 83%/76% (IT), 93%/100% (UK), 92%/92% (FR), and 83%/97% (ES) of pts treated with an IMiD/PI in 3L Tx, respectively, had prior exposure to the same agent class. In general, retreatment with a monoclonal antibody in 3L was very low: 14% in DE, 19% in IT, 0% in UK, 3% in FR, and 4% in ES. Prior to 3L Tx initiation, new data showed that triplets were frequent in the UK, FR, and ES, while doublets were more common in DE and IT in first-line (1L) and second-line (2L) settings. PI- and IMiD-based regimens were generally most frequent and driven by V- and R-containing regimens, respectively. The proportion of double class–exposed pts was 52.2% (DE), 33.2% (IT), 66.1% (UK), 78.6% (FR), and 68.8% (ES). Summary/Conclusion: This analysis describes RW Tx patterns in pts with RRMM initiating 3L Tx in Europe in 2016-2021. The 3L regimens were mostly IMiD based, and 1L and 2L regimens were R- and V-based; this was consistent with previous European studies and Tx recommendations based on clinical practice at the time of data collection. The MCR data showed changing trends from 2016-2018 to 2019-2021, with a strong shift toward triplets and anti-CD38 monoclonal antibody use in later LOTs, offering insights into recent RRMM clinical practice in Europe. Funding: GSK (Study 209840).Keywords: Treatment, Real world data, Multiple myeloma, relapsed/refractory